Background Within a period of three years, we identified 13patients in whom pure red-cell aplasia developed during treatmentwith recombinant human erythropoietin (epoetin). We investigatedwhether there was an immunologic basis for the anemia in thesepatients.
Methods Serum samples from the 13 patients with pure red-cellaplasia were tested for neutralizing antibodies that could inhibiterythroid-colony formation by normal bone marrow cells in vitro.The presence of antierythropoietin antibodies was identifiedby means of binding assays with the use of radiolabeled intact,deglycosylated, or denatured epoetin.
Results Serum from all 13 patients blocked the formation oferythroid colonies by normal bone marrow cells. The inhibitionwas reversed by epoetin. Antibodies from 12 of the 13 patientsbound only conformational epitopes in the protein moiety ofepoetin; serum from the remaining patient bound to both conformationaland linear epitopes in erythropoietin. In all the patients,the antibody titer slowly decreased after the discontinuationof treatment with epoetin.
Conclusions Neutralizing antierythropoietin antibodies and purered-cell aplasia can develop in patients with the anemia ofchronic renal failure during treatment with epoetin.
Source Information
From the Departments of Hematology (N.C., V.U., I.T.) and Nuclear Medicine (J.N.), Hotel-Dieu, Paris; INSERM Unité 362, Paris (N.C., V.U., I.T.); the Departments of Nephrology (B. Viron) and Internal Medicine (T.P.), Hôpital Bichat, Paris; Association pour l'Utilisation du Rein Artificiel dans la Region Parisienne, Saint Ouen (A.K.); the Department of Hematology, Hôpital Beaujon, Clichy (J.-J.K.); Centre de Traitement des Maladies Rénales Saint Augustin, Bordeaux (P.M.-D.); Polyclinique de Lagny, Lagny-sur-Marne (P. Michaud); the Department of Hematology, Centre Hospitalier Universitaire NeckerEnfants Malades, Paris V University, Paris (B. Varet); and the Department of Hematology and INSERM Unité 363, Institut Cochin de Génétique Moléculaire, Paris (P. Mayeux) all in France.
Address reprint requests to Dr. Casadevall at Hotel-Dieu, 75181 Paris CEDEX 04, France, or at nicole.casadevall{at}htd.ap-hop-paris.fr.
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